Provider Demographics
NPI:1659866432
Name:FOOT AND ANKLE CENTER OF IOWA LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE CENTER OF IOWA LLC
Other - Org Name:FOOT AND ANKLE CENTER OF IOWA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENHAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-391-7575
Mailing Address - Street 1:9006 OHIO ST STE 1
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-6139
Mailing Address - Country:US
Mailing Address - Phone:402-391-7575
Mailing Address - Fax:402-391-1508
Practice Address - Street 1:3720 N ANKENY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4605
Practice Address - Country:US
Practice Address - Phone:515-639-3775
Practice Address - Fax:515-964-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty